Saturday, November 20, 2010

Decompensated cirrhosis

Received 27 May 2010; received in revised form 19 October 2010; accepted 22 October 2010. published online 18 November 2010.
Accepted Manuscript
Background & Aims
We evaluated the long-term outcomes following antiviral therapy of patients with decompensated cirrhosis and hepatitis C virus (HCV) infection.
Seventy-five patients with HCV infection and decompensated cirrhosis received therapy with peginterferon alfa-2b and ribavirin. We compared adverse-event profiles and mortality rates between patients with or without sustained virological responses (SVRs). The mean follow-up time off therapy was 51±18 months (range 3–78 months).

Seven patients with HCV genotypes 1 or 4 (16%) and 17 patients with genotypes 2 or 3 (55%) achieved SVRs. The mean survival times were 53 months among patients that did not achieve SVRs (95% confidence interval [CI], 48–59 months) and 73 months among those that did achieve SVRs (95% CI, 67–80 months) (P=0.004). During the study, 25 patients died (2 with and 23 without SVRs). In the follow up period, 8/24 patients with SVRs (33.3%) and 49 of 51 without SVRs (96.1%) experienced further events of decompensation (P<0.0001).
The hospital re-admission rates for patients with and without SVRs were 7.4 and 56 per 1000 person-months, respectively (ratio of 7.5 without/with SVR; 95% CI, 4.0–16.0; P less then 0001). At the end of the follow-up period, the incidence of hepatocellular carcinoma was not associated with clearance of HCV.
Among patients with cirrhosis that is secondary to HCV infection and who have progressed to a stage of liver decompensation, an SVR following anti-viral therapy is a positive prognostic factor.

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